CASE STUDY: Charting a New Course Back to Paper, Agency Gains EMR Benefit

Technology that allows agencies to return to paper charting and gain the power of EMR

Everywhere home health and hospice agencies turn, they are being told of the benefits of enhanced productivity and better agency management information by automating their field staff with point of care software. As a result of these efforts, thousands of agencies have made the decision to purchase point of care software with substantial investments in laptop computers, tablets and hand-held devices. Agencies have realized that point of care software does in fact improve agency management with access to current information and data reporting and improvements in clinical accuracy and documentation. However, improvements in field staff productivity the results are much more controversial. Often clinicians do double work, document at home in the evening and per diem staff remain untrained on the technology due to the expense of hardware and software licenses. Additionally, the investment needed to equip, train and maintain the system is extremely substantial especially since laptops used in the field need to be replaced every three years at a minimum. This white paper will explore the benefits and challenges of current point of care software and offer alternatives to make their field staff more productive.

Background – Initial Point-of-Care Automation

Loma Linda Home Health is a hospital-based homecare agency established in 1970. The agency invested in a point of care software in 2000 and moved all their clinical staff from paper charting onto a laptop electronic medical record. Loma Linda has a field staff of approximately 50 full-time clinicians but also use significant levels of per diem staff that were not trained on the POC system and continued to chart on paper with data entry happening in the office.Loma Linda implemented their software system and with the expectation that they would achieve significant improvements in field staff productivity and better data and management reporting tools to improve decision making agency-wide. Loma Linda quickly realized that their management reporting and information allowed for significantly better agency management with an integrated software solution; however, they also realized that the point-of-care system wasn’t improving clinician productivity. In fact, the agency was faced with continuous decreases in clinical field staff productivity and significant decreases in clinician retention. To understand what was driving these issues, the agency conducted a staff survey which yielded two significant findings from a majority of respondents:

Additionally, in 2005 Loma Linda was feeling pressure to replace aging hardware, a significant investment of approximately $100,000 to purchase 50 heavy duty laptops to be used by clinicians in their home and not in the field. Loma Linda made a strategic decision to begin a search for alternative software solutions that would meet their goals of providing information for agency management decisions and by providing more flexibility in their charting methods.

The Solution – A hybrid approach – Paper Charts that create EMR data

In early 2007, Loma Linda decided to replace their current point of care system with SmartScribe from Select Data. SmartScribe, is a hybrid solution that combines charting, sophisticated scanning and software to convert the scanned chart into the Medicare 485 and an ongoing electronic medical record. The agency made a decision to replace their current system with a paper charting system combined with an electronic scanner because it was completed in less than 4 minutes, would provide access to current data and information and to address the productivity and morale issues with field staff.Now field clinicians complete their visits using a specially designed chart. The chart is scanned into the Select Data system where it is converted into an electronic medical record (EMR). The scanning process takes approximately 4 minutes. The system then makes the medical record available via the internet to the entire agency. Once scanned, the electronic medical record (EMR) can be viewed agency-wide. Now the billing department can drop a RAP or final bill, schedulers can schedule clinicians and aids for the episode, clinical staff can review the chart for accuracy and quality. Additionally once the Medicare 485 and care plan are complete they are placed on the physician portal or sent to the office for approval by the physician. In other words, the agency’s office operations haven’t changed significantly because the agency still has access to an electronic medical record that can be viewed by all. The only change has been with the clinical field staff going back to a paper charting method which the majority of clinicians prefer and has resulted in higher morale and productivity. The system has in effect bridged both worlds and lets the clinician take care of patients instead of doing data entry but still give the agency the management information it needs to run the agency smoothly.SmartScribe was implemented in May of 2007 along with Select Data’s back office modules. While all software implementations are stressful, the SmartScribe system has quickly created a balance between the needs of the field staff and agency administration. The Select Data suite of products is intuitive and user friendly so the staff have learned quickly and the majority of the field staff have easily adjusted to paper. Additionally, the charts are customizable to meet the individual documentation needs of the agency and can be changed as rules and regulations require.Most importantly, the majority of clinical field staff has improved morale and productivity using the SmartScribe system. It has been an easier change back to paper. As expected, some field staff would have preferred to stay using the computer system and the agency is looking into adding the Select Data SmartChart system which utilizes lightweight tablets for staff that wants to continue to document electronically. Select Data, offers agencies the flexibility to use a paper and tablet documentation system in one agency since the data is available using the same servers. Loma Linda believed that this flexibility and choice in clinical documentation was a key factor in their decision to go with the Select Data System and charting a new course back to paper.For more information on Select Data products and services, please email info@selectdata.com or call 1(800) SELECT1.